Telemedicine: The art of innovative technology in family medicine

Technology in medicine has been rapidly evolving over the past decade, greatly improving the quality and types of services providers can offer to patients. Physicians in training are eager to embrace these novel innovations, and medical school and residency educators strive to offer learning experiences of a high standard that are relevant. One example of an emerging healthcare innovation is telemedicine, which permits the provision of medical care to patients away from clinics and hospitals, bringing patient-centered care to the patient. It has proven to be cost-effective, improve health outcomes, and enhance patient satisfaction. This article describes the development and structure of our family medicine residency program’s telemedicine curriculum, first created in 2016 in response to the growing demand for this type of healthcare delivery model. There is discussion about the history of telemedicine, and about what contributed to its growth. A timeline of the steps taken to create our new telemedicine residency curriculum is reviewed, along with the key components that contributed to its success. The Lessons Learned section provides other educators insight into the strengths and opportunities revealed during the creation of the curriculum, and guidance on how the curriculum could be further enhanced.

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Investigating the Use of Telemedicine for Digitally Mediated Delegation in Team-based Primary Care: A Mixed-method Study (Preprint)

10.2196/preprints.28151 ◽

2021 ◽

Author(s):

Michael Knop ◽

Marius Mueller ◽

Bjoern Niehaves

Keyword(s):

Primary Care ◽

Technology Use ◽

Online Survey ◽

Cost Effective ◽

Innovative Technology ◽

Patient Centered ◽

Team Members ◽

Innovative Technologies ◽

Daily Work ◽

Centered Care

BACKGROUND Due to shortages of medical professionals, as well as demographic and structural challenges, new care models have emerged for finding innovative solutions to counter medical undersupply. Team-based primary care utilizing medical delegation appears to be a promising approach to address these challenges, but demands efficient communication structures and mechanisms to reinsure patients and caregivers receiving a delegated, treatment-related task. Here, digital healthcare technologies hold the potential to render these novel processes effective and demand-driven. OBJECTIVE The goal of this study is to recreate the daily work routines of general practitioners (GPs) and medical assistants (MAs) in order to explore promising approaches for the digital moderation of delegation processes and to deepen the understanding of subjective and perceptual factors that influence their technology assessment and use. METHODS In total, 19 interviews with 12 GPs and 14 MAs were conducted, seeking to identify relevant technologies for delegation purposes as well as the stakeholders’ perceptions of their effectiveness. Further, an online survey was conducted asking the interviewees to order identified technologies by their assessed applicability in multi-actor patient care. Interview data was analyzed using a three-fold inductive coding procedure. Multidimensional scaling was applied to analyze and visualize survey data, leading to a triangulation of results. RESULTS Our results suggest that digital mediation of delegation underlies complex, reciprocal processes and biases that need to be identified and analyzed in order to improve the development and distribution of innovative technologies, as well as to improve our understanding of technology use in team-based primary care. Nevertheless, medical delegation enhanced by digital technologies, such as video consultation, portable electrocardiograms (ECGs), or telemedical stethoscopes, is able to counteract current challenges in primary care due to its unique ability to ensure both personal, patient-centered care for patients and create efficient and needs-based treatment processes. CONCLUSIONS Technology-mediated delegation appears to be a promising approach to implement innovative, case-sensitive, and cost-effective ways to treat patients within the paradigm of primary care. The relevance for such innovative approaches increases at times of tremendous need for differentiated and effective care, like during the ongoing COVID-19 pandemic. For successful and sustainable adoption of innovative technologies, MAs represent essential team members. In their role of mediators between GPs and patients, MAs are potentially able to counteract resistance towards using innovative technology on both sides and compensate for patients’ limited access to technology and care facilities.

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Patient Centered Medical Home transformation at an academic medical center

Journal of Hospital Administration ◽

10.5430/jha.v5n1p34 ◽

2015 ◽

Vol 5 (1) ◽

pp. 34

Author(s):

Randy Wexler ◽

Jennifer Lehman ◽

Mary Jo Welker

Keyword(s):

Family Medicine ◽

Patient Outcomes ◽

Medical Home ◽

Medical Center ◽

Academic Medical Center ◽

Lessons Learned ◽

Patient Centered Medical Home ◽

Model Of Care ◽

Patient Centered ◽

Academic Medical

Background: Primary care is playing an ever increasing role in the design and implementation of new models of healthcare focused on achieving policy ends as put forth by government at both the state and federal level. The Patient Centered Medical Home (PCMH) model is a leading design in this endeavor.Objective: We sought to transform family medicine offices at an academic medical center into the PCMH model of care with improvements in patient outcomes as the end result.Results: Transformation to the PCMH model of care resulted in improved rates of control of diabetes and hypertension and improved prevention measures such as smoking cessation, mammograms, Pneumovax administration, and Tdap vaccination. Readmission rates also improved using a care coordination model.Conclusions: It is possible to transform family medicine offices at academic medical centers in methods consistent with newer models of care such as the PCMH model and to improve patient outcomes. Lessons learned along the way are useful to any practice or system seeking to undertake such transformation.

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Sickle cell disease pain management and the medical home

Hematology ◽

10.1182/asheducation.v2013.1.433.3850724 ◽

2013 ◽

Vol 2013 (1) ◽

pp. 433-438 ◽

Cited By ~ 1

Author(s):

Jean L. Raphael ◽

Suzette O. Oyeku

Keyword(s):

Pain Management ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Medical Home ◽

Cost Effective ◽

Cell Disease ◽

Patient Centered ◽

Centered Care ◽

The Individual ◽

Effective Models

Pain is the most common cause for hospitalization and acute morbidity in sickle cell disease (SCD). The consequences of SCD-related pain are substantial, affecting both the individual and the health care system. The emergence of the patient-centered medical home (PCMH) provides new opportunities to align efforts to improve SCD management with innovative and potentially cost-effective models of patient-centered care. The Department of Health and Human Services has designated SCD as a priority area with emphasis on creating PCMHs for affected patients. The question for patients, clinicians, scientists, and policy-makers is how the PCMH can be designed to address pain, the hallmark feature of SCD. This article provides a framework of pain management within the PCMH model. We present an overview of pain and pain management in SCD, gaps in pain management, and current care models used by patients and discuss core PCMH concepts and multidisciplinary team–based PCMH care strategies for SCD pain management.

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Quality and safety by design

BMJ Quality & Safety ◽

10.1136/qshc.2006.020347 ◽

2006 ◽

Vol 15 (suppl 1) ◽

pp. i1-i3 ◽

Cited By ~ 11

Author(s):

J B Battles

Keyword(s):

Healthcare Delivery ◽

Clinical Work ◽

Design Methods ◽

Quality And Safety ◽

Healthcare Organizations ◽

Patient Centered ◽

Framework Design ◽

Design Attributes ◽

Centered Care

Rather than continuing to try to measure the width and depths of the quality chasm, a legitimate question is how does one actually begin to close the quality chasm? One way to think about the problem is as a design challenge rather than as a quality improvement challenge. It is time to move from reactive measurement to a more proactive use of proven design methods, and to involve a number of professions outside health care so that we can design out system failure and design in quality of care. Is it possible to actually design in quality and design out failure? A three level conceptual framework design would use the six quality aims laid out in Crossing the quality chasm. The first or core level of the framework would be designing for patient centered care, with safety as the second level. The third design attributes would be efficiency, effectiveness, timeliness, and equity. Design methods and approaches are available that can be used for the design of healthcare organizations and facilities, learning systems to train and maintain competency of health professionals, clinical systems, clinical work, and information technology systems. In order to bring about major improvements in quality and safety, these design methods can and should be used to redesign healthcare delivery systems.

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Expanding Role of Telephone Systems in Healthcare

Health Care Delivery and Clinical Science ◽

10.4018/978-1-5225-3926-1.ch030 ◽

2017 ◽

pp. 564-598

Author(s):

Jing Shi ◽

Ergin Erdem ◽

Heping Liu

Keyword(s):

Performance Metrics ◽

Healthcare Delivery ◽

Patient Acceptance ◽

Patient Centered ◽

Healthcare Settings ◽

Challenges And Opportunities ◽

Centered Care ◽

The Cost ◽

Telephone Systems

The telephone systems in healthcare settings serve as a viable tool for improving the quality of service provided to patients, decreasing the cost, and improving the patient satisfaction. It can play a pivotal role for transformation of the healthcare delivery for embracing personalized and patient centered care. This chapter presents a systematic review of new developments of healthcare telephone system operations in various areas such as tele-health. Current research on topics such as tele-diagnosis, tele-nursing, tele-consultation is outlined. Specific issues associated with the emerging applications such as underreferral, legal issues, patient acceptance, on-call physician are discussed. Meanwhile, the architecture and underlying technologies for healthcare telephone systems are introduced, and the performance metrics for measuring the system operations are provided. In addition, challenges and opportunities related with improving the healthcare telephone systems are identified, and the potential opportunities of optimizing these systems are pointed out.

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A Computational Perspective of Knowledge Empowerment for Healthcare Decision Making

Health Literacy ◽

10.4018/978-1-5225-1928-7.ch007 ◽

2017 ◽

pp. 134-155

Author(s):

Timothy Jay Carney

Keyword(s):

Public Health ◽

Computational Models ◽

Healthcare Delivery ◽

Research Literature ◽

Healthcare Decision ◽

Patient Centered ◽

Healthcare Decision Making ◽

Computational Perspective ◽

Centered Care ◽

The Relationship

People in a variety of settings can be heard uttering the phrase that “knowledge is power” or the relatively equivalent concept that “information is power.” However, the research literature in particular lacks a simple and standardized way to examine the relationship between knowledge and power. There is a lack operational quantitative definitions of this relationship to adequately support the building of complex computational models used in addressing some longstanding public health and healthcare delivery issues like differential access to care, inequitable care and treatment, institutional bias, disparities in health outcomes, and eliminating barriers to patient-centered care. The objective of this discussion is to present a relational algorithm that can be used in both conceptual discussions on knowledge empowerment modeling, as well as in the building of computational models that want to explore the variable of knowledge empowerment within computer simulation experiments.

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The role of innovative technology to improve patient centered care

Innovation in Health for Society ◽

10.31603/ihs.5290 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Fira Nabilla ◽

Suphanna Krongthaeo ◽

Ragil Setia Dianingati ◽

Eva Annisaa'

Keyword(s):

Chronic Disease ◽

Innovative Technology ◽

Health Providers ◽

Literature Study ◽

Patient Centered ◽

Therapeutic Success ◽

Use Of Technology ◽

Chronic Disease Patients ◽

Centered Care

Chronic disease is a long term disease. Treatment performed by patients is also routine and continuous to achieve therapeutic success as well as to avoid complications that can be occurred. Adherence is an important factor to reduce complications of chronic disease. There are some efforts that need to do to increase compliance, such as providing information about drug usage from health providers. The use of technology can also be an option as a facility to increase compliance, such as using audiovisual media as an additional means of providing information and short message services or a mobile application for medication reminders on smartphones. This article provides an overview of the role of technology in increasing adherence to patients especially those who are suffering from chronic disease. This article is based on a literature study from some literature or research results. The reviewed literature shows that the use of video in providing information about drugs, sending short messages, and the use of mobile medication reminders to take medication has an effect on increasing adherence significantly in chronic disease patients. The use of technology is effective and efficient in increasing adherence of chronic disease patients.

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A Computational Perspective of Knowledge Empowerment for Healthcare Decision Making

International Journal of Civic Engagement and Social Change ◽

10.4018/ijcesc.2016070102 ◽

2016 ◽

Vol 3 (3) ◽

pp. 16-35

Author(s):

Timothy Jay Carney

Keyword(s):

Computational Models ◽

Healthcare Delivery ◽

Research Literature ◽

Healthcare Decision ◽

Patient Centered ◽

Simulation Experiments ◽

Healthcare Decision Making ◽

Computational Perspective ◽

Centered Care ◽

The Relationship

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Role of laboratory medicine in collaborative healthcare

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2017-0853 ◽

2018 ◽

Vol 0 (0) ◽

Author(s):

Ian D. Watson ◽

Patricia Wilkie ◽

Amir Hannan ◽

Graham H. Beastall

Keyword(s):

Clinical Laboratory ◽

Point Of Care ◽

Healthcare Delivery ◽

Continuing Professional Development ◽

Laboratory Medicine ◽

Sources Of Information ◽

Patient Centered ◽

Laboratory Service ◽

Laboratory Services ◽

Centered Care

Abstract Healthcare delivery and responsibility is changing. Patient-centered care is gaining international acceptance with the patient taking greater responsibility for his/her health and sharing decision making for the diagnosis and management of illness. Laboratory medicine must embrace this change and work in a tripartite collaboration with patients and with the clinicians who use clinical laboratory services. Improved communication is the key to participation, including the provision of educational information and support. Knowledge management should be targeted to each stakeholder group. As part of collaborative healthcare clinical laboratory service provision needs to be more flexible and available, with implications for managers who oversee the structure and governance of the service. Increased use of managed point of care testing will be essential. The curriculum content of laboratory medicine training programs will require trainees to undertake practice-based learning that facilitates interaction with patients, clinicians and managers. Continuing professional development for specialists in laboratory medicine should also embrace new sources of information and opportunities for collaborative healthcare.

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The Impact of COVID-19 on the Prevalence and Perception of Telehealth Utilization. (Preprint)

10.2196/preprints.34074 ◽

2021 ◽

Author(s):

Khalid Adnan Shamiyah ◽

Simon Whitebridge ◽

Nitya Kumar ◽

Stephen Atkin ◽

Khawla Fuad Ali ◽

...

Keyword(s):

Social Media ◽

Public Attitudes ◽

Healthcare Delivery ◽

Mena Region ◽

Patient Centered ◽

Patient Acceptability ◽

Online Social Media ◽

Centered Care ◽

Future Utility ◽

The Impact

BACKGROUND Due to the COVID-19 pandemic, telehealth has emerged as a safer way to access healthcare. The telehealth industry has been rapidly expanding over the last decade as a modality to provide patient-centered care. However, the prevalence of its use and patient acceptability remains unclear in the Middle East and North Africa (MENA) region. OBJECTIVE The primary aim was to assess the prevalence of telehealth use before and during the pandemic by utilizing social media (Instagram) as an online platform for survey administration across different countries simultaneously. Our secondary aim was to assess the perceptions regarding telehealth usage amongst those utilizing it. METHODS An online social media platform (Instagram) that reaches 130,000 subjects daily, was used to administer a questionnaire that assessed the current prevalence of telehealth use and public attitudes and acceptability towards this modality of healthcare delivery during the COVID-19 pandemic. RESULTS 1524 respondents participated in the survey (females 89.3%; age range 25-38) of whom 91.2% lived in the GCC. Prior to COVID-19, 1440 (88%) had no exposure to telehealth. Following the covid-19 pandemic telehealth usage increased by 237% to a total of 644 users (40%) (follow-up consultations (n=410, 47%); first-time consultations (n=348, 40%)) that was associated with older age (p=0.001), having one or more comorbidities (p=0.001), taking one or more pills (p=0.001), living in the GCC (p=0.003). Those who reported using telehealth (n=679), 247 (36.4%) reported their willingness to continue using telehealth, 254 (37.4%) were unsure and 178 (26.2%) did not wish to continue to use telehealth after the COVID19 pandemic. An inverse relationship between telehealth usage and the increasing number of medical comorbidities was shown (OR= 0.76, p= 0.023). Respondents using messaging or video telehealth usage were more likely recommend virtual visits than those who used audio calls (OR= 0.49, p= 0.024). Overall, there was general satisfaction with telehealth usage and respondents found telehealth to be equally effective to in-person visits. CONCLUSIONS Telehealth usage increased dramatically and was found to be acceptable though less so if there were other comorbidities; however, further innovation to increase telehealth acceptability is needed if this is to have greater future utility in healthcare delivery.

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